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February 2007

Two challenges for health communicators in the coming decade

In this short piece, Journal of Health Communication editor Scott Ratzan reflects on editing the journal during its first ten years.  He notes two important challenges for health communicators:

• It will be difficult to attain health while the focus remains on diseases themselves, and not the underlying determinants of them (economic, political and/or social).
• How to best reach the public and mobilize resources for health--media approaches may not be the only solution.  Health communication should be in all places where health decisions are made, such as homes, communities, schools, workplaces, academic institutions, and governments.

As the Journal continues to present evidence to preserve, promote, and protect health worldwide, our THCU team will endeavor to help you put it into practice!

Ratzan, S. C. (2006). The Journal of Health Communication: International Perspectives: Editor's reflection--the first decade. Journal of Health Communication, 11(1), 5-6.           

Health communication literature gaps – a review of the past decade

In an attempt to assess the health communication literature gaps, the authors of this article review the characteristics of the 321 articles accepted for publication in the Journal of Health Communication over the past decade. Some of the most interesting findings are summarized below.

80% of regular articles and 95% of the articles in supplements had a primary author from the US

Health Topics Covered (1) of 255 peer-reviewed, regular articles

Health Topic	Percentage of Regular Articles (n = 255)
Smoking/tobacco	15%
HIV/AIDS	14%
Cancer-specific	13%
No specific focus	12%
Alchohol/drugs	8%
Family planning/pregnancy	5%
Crime/violence/injury	5%
Pharmaceuticals	4%
Diet/nutrition	3%

62% of articles did NOT make use of theory.

• Social cognitive theory most often used; followed by Health Belief Model
• 7 original theoretical frameworks proposed throughout past 10 years

Media channels covered (of the 219 articles that focused on channels)

Channel	Percentage of Articles (n = 219)
Multimedia	21%
Advertisements	18%
News media	13%
Peer networks	12%
Doctor-patient	11%
Technology-assisted	7%
Edutainment	6%

Based on their review, the authors make some suggestions for filling the literature gaps:

• Increase authors/studies from outside the USA..
• Give more attention to e-health.
• Increase publications on diet, physical activity and chronic disease.
• Pay more attention to rhetorical (critical, historical) work in health communication.
• Expand quantitative methodologies to include meta-analyses, scale development and discourse analyses.
• Include more qualitative research in health communication.
• Increase theoretical contribution and test/expand current theoretical ideas as well as novel theory development.

Freimuth, V. S., Massett, H. A., & Meltzer, W. (2006). A descriptive analysis of 10 years of research published in the Journal of Health Communication. Journal of Health Communication, 11(1), 11-20.

Effectiveness in health communication – It’s all about process

In this article, Noar discusses whether campaigns can truly impact public health and the lessons learned about media campaign effectiveness and suggests direction for health communication literature for the future. 

Can mass media campaigns promote public health? 

A review of meta-analyses suggests a positive answer, showing that mass media campaigns can have small effects on health attitudes, knowledge, and behaviour.  When considering the large reach of mass media, small-to-moderate effects can equate to great impact on public health. 

What lessons does the past 10 years of campaign literature hold? 

Noar purports that campaigns can be effective if they adhere to established principles of campaign design, as follows (adapted/reproduced from Table 1, p. 25):

• Conduct formative research with target audience for full understanding of behaviour and the problem area. This includes pre-testing messages to test their appropriateness and effectiveness.
• Use theory to ground the campaign.
• Segment audience into homogenous subgroups of key characteristics to design messages specifically tailored to that segment.
• Design messages, targeted to the audience, that are new and innovative and foster interpersonal discussions.
• Select channels that are widely viewed by audience and strategically position campaign materials within them.
• Conduct process evaluation by monitoring and collecting data on campaign implementation to ensure high message exposure: reach and frequency. This will help one understand why campaigns were effective or why they were not.
• Conduct outcome evaluation. Use strong(er) designs where possible, such as time series or pretest/post test, to reduce threats to internal validity.

What are the priorities for health communication literature for the future? 

Theoretical advances/development

• Designers should choose guiding theories carefully as they differ in their implications for design and behaviour change.
• Develop message-based theories to help understand how communication processes work within campaigns.
• Measure and evaluate theoretical constructs used in the campaigns.

Message design & development

• Campaign scholars and those in other disciplines should engage in innovative collaborate efforts.
• Find novel ways of encouraging audiences to discuss campaign messages with others.
• Increase investment in interactive health communication technology.

Campaign evaluation

• Increase efforts to undertake and report process evaluations.
• Strive for stronger research designs in outcome evaluation.

Campaign replication and dissemination

• “More” may not always be better: multi-channel campaigns make it difficult to isolate which components were most successful and makes replication challenging.

Overall, Noar notes that health communication is in an era of "conditional effects" where health communicators are not so much discovering new principles of campaign design but putting established principles to effective and creative use.

Noar, S. M. (2006). A 10-year retrospective of research in health mass media campaigns: Where do we go from here? Journal of Health Communication, 11(1), 21-42.

Representing a full range of voices and health issues in the media

In this article, Kline reflects on research showing that in the mass media, in the last 10 years, content has focused on challenges to physical and mental health and such representations of health tend to be misleading, inaccurate, or stereotypical. She also notes that privileged voices tend to be emphasized in the media. She concludes a need to

• expand research into wider varieties of media domains,
• focus on a wider range of sociocultural groups and how they are affected/impacted by health content in popular media,
• expand the field of health issues that garner attention (e.g., addressing more “invisible” health problems such as chronic fatigue syndrome), and
• explore how other voices and competing interests are represented in the media.

Kline, K. N. (2006). A decade of research on health content in the media: The focus on health challenges and sociocultural context and attendant informational and ideological problems. Journal of Health Communication, 11(1), 43-59.

New technologies: Insight on effectiveness from the past 10 years

Computer technology continues to provide unique and economic benefits for health communication efforts. A review of the past decade of research indicates that a number of new technologies have been shown to be effective.

Stand-alone computer-based communication

The use of a stand-alone computer (without Internet connection) pre-loaded with the relevant health material allows the delivery of health information in novel places (e.g., computer kiosks in grocery stores).

Web-based communication

Newer web-based initiatives are moving towards more interactive communication over placing print materials on a website.

Telephone-based communication

Computer-driven telephoning is used to deliver messages and obtain information.

Computer-based tailoring

Tailored messages can incorporate different media (e.g., text, video, audio) to address different theoretical constructs (e.g., different stages of change, health beliefs, self-efficacy).

Suggs notes that there are a number of drawbacks to computer-based communication including: access problems (the “digital divide”), the quality of information available, health literacy, privacy, and technological compatibility.  Nonetheless, computer-based communication can provide tailored information to large numbers of people in a generally less-expensive way.  Future research needs to focus on the variables related to successful message tailoring; the most efficacious technological channels for health communication; and evaluations, which help demonstrate which new technological approaches work best. 

Suggs, L. S. (2006). A 10-year retrospective of research in new technologies for health communication. Journal of Health Communication, 11(1), 61-74.

Risk communication: Key lessons from the last 10 years

The last 10 years has produced much work on how to effectively communicate risk messages. In this article, McComas points out some of the key findings, which have and will continue to dominate the risk communication research agenda.

• Risk decisions have a large subjective component.
  • People make risk decisions based not only on their knowledge of the risk, but also how they feel about it (the affect heuristic)
  • The interaction of risk events with social processes heighten or decrease people’s perceptions of risks and thus influence their risk behaviour decisions (social amplification of risk)
• While media coverage may affect societal judgments of risk, it does not have a large effect on personal judgments. 
  • Personal perceptions are more likely to be influenced by interpersonal communication.
• “Mental models,” constructed using interviews with experts and target audience members to investigate different understandings of risk, are useful in constructing appropriate risk messages.
• Risk comparisons can result in positive reactions from the public, with trust in the source being a key moderator.
• People are likely to perceive greater risks when they do not feel trust or credibility in the messenger. 
• Target audience input is central to the successful portrayal of risk--it helps them receive the information they require for personal decision-making; and makes policy-making more fair and legitimate. 

McComas, K. A. (2006). Defining moments in risk communication research: 1996-2005. Journal of Health Communication, 11(1), 75-91.

Talking about health with providers and in close relationships

The last 10 years has produced much work on interpersonal communication in health contexts. In this article, Duggan points out some of the key findings on health communication between patients and providers and within close relationships, which have and will continue to be prominent research foci.

Provider-patient relationships

Duggan notes that better patient outcomes are predicted by information giving; interpersonal sensitivity; partnership building; longer interactions with patients; increased patient-centred communication; perceptions of relationships; and participation in the decision-making. He also mentions the importance of patients’ communication in consultations; communication skills and training for patients; and advocacy for patient activism.

Duggan suggests the following future directions for provider-patient research:

• Theoretical work should investigate how and why health outcomes are influenced by communication behaviours.
• We need to consider a broader scope of health outcomes, beyond patient satisfaction (such as improved health, quality of life, health costs).
• More research is needed on improved outcomes from the providers’ perspectives.
• We need to consider the emotional well-being of the provider, its effects on communication behaviours, and how a relationship-centred approach may influence the provider.
• Health literacy should be more broadly investigated to consider verbal and nonverbal communication in addition to written materials.

Health and interpersonal relationships

Ten years of research indicates that

• interpersonal communication can make coping with health uncertainty difficult,
• stigma often complicates interpersonal communication around illness,
• there is a central role for family communication about health, and
• social support can help individuals cope with stress and enhance their well-being.

Duggan concludes:

• Research needs to further address the boundaries and conditions of disclosure from the relationship perspective.. 
• More work is needed on how developmental issues influence interpersonal relationships in health care (for example, when dealing with an ill child).
• More research is required on communication with older adults and how they should be accommodated and communicated with in ethical ways and how additional parties should be involved in the communication (e.g., a caregiver).

Duggan, A. (2006). Understanding interpersonal communication processes across health contexts: Advances in the last decade and challenges for the next decade. Journal of Health Communication, 11(1), 93-108.

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